the answer is whomever arrived first. — Isaac

That's the prevailing idea and it's wrong.

In all likelihood, yes. 90% of hospitalisations are associated with comorbidities, so if this particular patient's comorbidity is obesity there's a very strong chance their hospitalisation would have been avoid without it. — Isaac

Nope, those percentages are much lower than 90% which is why it's not the same and, moreover, these are lifestyle choices that predate Covid, meaning they weren't culpable choices to begin with.

You are 'refusing to answer' the fairly simple question about what makes vaccination, as method of avoiding hospitalisation, one worthy of use in triage judgements but not any other method, such as general health, safety precautions, and non-pharmaceutical interventions. — Isaac

I have answered it, that you disagree is in no way, shape or form about me avoiding the question. My pretty straightforward questions get ignored or the subject is changed. But for your benefit, let me repeat it. It's about causality. Being fat isn't a conditio sine que non for requiring an IC bed after a COVID infection. But for those people that if they were infected by COVID that then would require an IC bed not getting a vaccination is a conditio sine que non, because they would've avoided the IC bed in 99% of cases.

Especially in light of the fact that healthcare is a privilege and the money that goes into it is rationed and the care itself as a result too, it's perfectly adequate that if the prevailing consensus of practitioners in that system is to get a vaccination that not getting one might have consequences in decisions how to ration care under specific circumstances.

In other words, I would consider it entirely ethical to prioritise care for those people who adhere to generally accepted advice as opposed to those that don't.

Got a fat patient as a result of diet choices and a normal proportioned person? All things being equal, if the choice needs to be made, by all means, go for the normal proportioned person.

And I have discussed this with medical practitioners here in the Netherlands and they aren't averse to the idea. How about treating a 90-year old woman with heart surgery to provide her a new heart valve? She takes up resources too. Do it or not do it?

I'll repeat, healthcare isn't a right, it's a privilege. When deciding who gets that privilege, people's behaviours can be taken into account and I think they should. I've argued we should, under limited circumstances, and think legal jurisprudence has sufficient and detailed enough doctrine in the area of causality and negligence to make a workable protocol for it that results in a fair distribution of limited resources.

The further we dive into hypotheticals, the more I am convinced the point of this is allowing you to fantasize of the punishment you would so eagerly apply to people whose you choices you disagree with.

Maybe, in such a case as you describe, it is enough to consider it a devilish dilemma that I would not wish upon anyone. To have to make such a choice may haunt someone for the rest of their life, yet here you are treating it like you have all the answers - like it is a game. — Tzeentch

Again, the interpretation that I'm looking to "punish" is your own. I don't think what I've described is a devilish dilemma; it's a rather clear hypothetical that people on the other side of the argument seem to refuse to want to answer because the answer seems rather clear - ethically speaking. It just so happens that clear answer contradicts the position you've assumed resulting in enough cognitive dissonance that you prefer to make this about me. That's just a pathetic way of trying to change the subject.

Yes, a very difficult decision in real life that some people actually have to make. Having a protocol at hand if such a situation arises would actually alleviate the burden on people and relieves them from personal responsibility when having to make such decision, which is precisely why - in real life - hospitals use protocols for all sorts of situations.

Thank you.

I can see how in disaster triage making decisions like this is much harder. And I'll definitely grant that the "protocol" I suggested doesn't work in many circumstances. But we have triage all the time also without the pressure. When I had to go to the hospital with my son there weren't enough IC beds available either (pre-Covid). Just a confluence of circumstances.

The 5 principles I mentioned aren't my invention; they're actually used to write protocols and in arriving at decisions. If you're confronted with a triage situation, after assessing it and it fits the protocol, you can follow the protocol.

But let's start somewhere. Let's assume you have perfect knowledge and there are two patients, male, 26-years old, both have COVID, one is vaccinated the other isn't. Both need a vent and there's only one vent. Who gets the vent? Is this an obvious case to you? If not, why not?

You keep suggesting I don't know what I'm talking about in a public forum so it would be appropriate to actually explain why. Just because you're a nurse doesn't make you an expert on ethics.

Again, this is not the kind of decision a triager makes. Stay in your lane, buddy. — frank

Again, maybe actually make an argument.

EDIT: In fact, I find the idea, that because "triager" does something in a certain way that therefore we can't have an opinion about how ethics should influence decisions that actually had to be made last year, a bit ridiculous. Especially on a philosophy forum.

As an aside, what you describe isn't institutionalized racism, but institutionalized classism. — Hanover

I can see how that may have come across like that so let me clarify a bit more how things are going in the Netherlands. Police, public prosecution and judges in the Netherlands like "getting" Johnny Foreigner, they're more often picked out, more often prosecuted and sanctioned more harshly and they are generally part of the lower socio-economic backgrounds based on correlation. That's the part which is "institutionalised racism".

The second part would be where it concerns local governments, that I generally either know them directly or "I know a guy that knows a guy" and since I'm considered a "more upstanding" citizen than a poorer person (because we measure everything in money, including someone's moral worth) I'm treated differently. That's typical classicism. And also shows where upper middle class people make up the majority of employees in the prosecution and judges, those who write the laws, those who enforce administrative penalties and work at the tax office. So they speak "my language", which makes it a million times easier for me to give them a call first, discuss my case, maybe meet in person and ask for leniency and generally try to bend or avoid the rules. And it works. Or at least, I'm pretty certain it's not all just me being a glib lawyer.

That you support the right for others to make stupid decisions is a principled one, and one that I can understand, but it's not one I would personally spend time fighting for. Should you win the battle and secure the common man's inherent right to be stupid, I'm not certain the world will be better off. — Hanover

We have a bible belt where people don't get the measles vaccine either and every 10-15 years or so there's an outbreak. Maybe longer ago there was an obligation, I don't know, but not for as long as I've been around. I don't think Covid is deadly enough to warrant a vaccine obligation (otherwise we can start with mandating flu boosters in the US and EU as well). And if it isn't obligated, I don't see any reason why people would have to submit proof or carry passports.

Another statement as if it's true. Why don't you go express the right to healthcare in countries that don't have any? Or maybe imagine living 500 years ago? Healthcare is a privilege reserved for mostly affluent nations. Everybody else is mostly screwed. It's the same with human rights; they are a privilege.

There's an important distinction between thinking everybody should have access to healthcare and everybody is entitled to healthcare.

The ethics of triage:

1. autonomy, patients can decide if they want care or not and if there are options in type of care, select the option of their preference.
2. normaleficence, don't unnecessarily increase risk to harm others or intentionally harm others.
3. beneficence, do what is right for the patient.
4. justice, treat similar cases, similarly, treat dissimilar cases, differently. Justice as fairness.
5. fidelity, patients ought to be able to trust doctors.

How does my proposal fit in? Pretty well I'd say. A doctor is screwed on 2, 3 and 5 anyways, as a choice for one or the other will harm the other, won't do one of them any good and probably will be experienced as a breach of trust by the person on the wrong side of the equation.

On autonomy it's interesting that this is the primary consideration but already three posters are getting hysterical about including patient autonomy exercised before coming into the hospital. That's rather inconsistent if you ask me.

My proposal rests most squarely on a consideration of justice. If you willfully make decisions that contribute to you requiring care and those decisions are proximate causes to you requiring care, then all other things being equal, you are not the priority patient.

Well, thank you for that meaningless statement. And why would that be?

People seem to misunderstand healthcare isn't an entitlement but a privilege. So we can definitely decide to set rules for people to receive that privilege.

These are all mitigated by circumstance. Punishment will almost always be less severe in such cases. — Isaac

Also, this is actually not true. People from lower socio-economic backgrounds are disproportionally sanctioned for breaking laws with less leniency applied. That's in part institutional racism, in part network corruption and part knowing how to deal with authorities (and sometimes even just speaking the language and understanding your rights).

Most laws that are passed disproportionally benefit rich people.

Riding a motorcycle is a conscious choice. — Isaac

Yes, but not a proximate cause of an accident and still considered generally safe, which is why some cars aren't permitted on roads.

You're suggesting that above the value of human life, we should hold the value of 'teaching them that actions have consequences', or the value of creating a more 'deserving' society by weeding out those less worthy of its benefits. — Isaac

I think all lives are equally valuable but for any contributory negligence. I don't see any good reason to prioritise young people over old people, for instance, but I do see good reason to prioritise help if someone culpably has put himself in a particularly dangerous situation. In most cases this choice isn't forced because there's plenty of room and resources available with acceptable waiting lists for non urgent healthcare. But in a triage situation, sure, I don't think someone in a car accident should not be helped because the IC would be full with unvaccinated Covid patients. I'd kick one of those Covid patients off the IC without any guilt.

Your disdain for people who make different decisions than you, regardless of their reasons, shines clearly through your posts. — Tzeentch

It's not disdain to insist choices have consequences. Nor is it novel. That choices should have consequences is clear. And your "but they paid their entire lives" doesn't make them special, so did the 90 year old granny.

Except she got vaccinated.

You keep thinking I would deny health care to unvaccinated people but I've been very clear under which circumstances.

Like it is a game, it is stated that "people should be booted out of the IC." — Tzeentch

Under rather specific circumstances, which you keep happily ignoring. Do you disagree with the examples I gave?

Should doctors treat car passengers above motorcycle riders in a RTA? Cars are a demonstrably safer means of travel and such information is publicly available, so if someone willfully avoids a practice which reduces their risk of hospitalisation, they should feel the consequences, right? — Isaac

No. The difference is when you have a victim of the person exceeding the speed limit and the person who exceeded the speed limit. If that information would be available at the moment if having to decide who to operate first, the moral decision is clear. It's about conscious choices and whether that choice is a proximate cause or not.

Those with learning difficulties will need to be identified (we can't hold them to the same standard of willful disregard), those with English as a second language, recent immigrants, the minorities in culturally oppressive groups like women and older children... All shunted to the back of the queue for refusing advice they barely understood or had little control over? — Isaac

Of course we can and we already do. A learning disability is no excuse for paying taxes late, parking in the wrong zone or not knowing how to lodge a complaint against a government institution. These aren't solved by tweaking the rules but by providing systems of care.

There's nothing sick about it and has nothing to do with revenge. Only an idiot would interpret it that way. But you're probably one of the idiots who didn't get vaccinated and feels personally attacked.

If people wilfully refuse preventive treatment and then get the illness they could've prevented then obviously they ought to move down the line of priorities when doctors have to make decisions about where to commit resources. So if you're a strapping young lad without a vaccination and you need an IC bed and a 90 year old vaccinated granny needs one as well, you both have Covid but there's only one bed, you can most definitely go fuck yourself. If she fell down the stairs and you have Covid and both need the bed you can still fuck yourself. Only when you get into the hospital for something else but Covid should regular rules apply.

That said, I think this should be the case with respect to all vaccinations. Children who can't decide for themselves yet exempted or course.

Yes.
Against.
Against.

The vaccine is available and everybody that wants to get vaccinated can (in Europe and the US, what we seem to be talking about). Vaccination willingness seems to be sufficient to avoid deathly illness. More vaccination might lower hospital admittance and IC use but all that is temporary anyway as the cohorts that would end up in the hospital either die or get immunity through having the disease.

The genie is out of the bottle any way, we're going to have to live with Covid and after vaccination/first infection it really doesn't seem worse than the flu. We'll get plenty of new variants. We shouldn't be living in fear. Living healthily is the best protection.

As much as I hate it, I do believe in the freedom for other people to make stupid choices. We never mandated measles vaccines, which was much, much worse in terms of infection rate and slightly higher death rate but also risk of blindness.

We're too scared.

Also fuck boosters except for the elderly and those with known comorbidities and send vaccines to countries that can't afford them. That will save many more lives than boosters can.

Finally, if a hospital is ever faced with a triage situation they ought to boot unvaccinated Covid patients out of the IC regardless of other considerations like age, likelihood of survival, etc. Some consequences ought to be felt.

EDIT: I also think we should be much quicker in closing off borders if a new variant is detected in another country. Just stop all non-essential travel and require quarantine if you travel from such a country until its clear whether the variant is similar or worse than the existing variant.

Well at least you don't live in Afghanistan.

curious, are you aware when the last time was they had to set up triage because of a "serious" flu?

OK, noted that all you can do is bitch. I'm happy to know I can ignore all your posts from now on on anything to do with politics.

to add to my other post, within a time frame necessary to stave off the worst of the climate crisis and obviously the plan should be feasible not some fairy tale.

Parliament. Representation. It seems you have a lot of problems understanding government as a cooperative endeavour and only see it as an oppressive master. That interpretation is simply lazy.

But let's assume it's right, I've only ever heard you bitch about governments. Lay out how to transition from the type of government we have now, to what you think we need, and then how that new society is going to tackle the climate crisis. I want a plan, not just empty criticisms that we keep wasting time on waylaying. Prove that you're not just an inane ideologue.

Because she understands, apparently better than you, that to effect change you go bother the people with the power to do so.

Well, we’ve all been raised to believe the government will fix our problems, so it’s probably true that people will not collectively mobilize until it is too late. — NOS4A2

Nobody has been raised that way but nice caricature to make yourself feel better I suppose.

Says the guy totally misrepresenting what I said. Maybe next time read first and write later.

Can't read, can you?

Indeed.

You've offered nothing in way of proof about something serious, which you claim is happening in the US. I just like to call it a third world country because it apparently is, where job security is so low, people will prioritise money over other people's lives. And healthcare is apparently at such an abysmal low level they've forgotten what their job is.

I didn't swear unless your delicate sensibilities include "bullshit" as a swear word. I have two close friends who are doctors and neighbours too who work in hospitals. I don't know in which dreadful third-world country you work where the oath doesn't mean anything but they actually work with their oath in the back of their mind all the time and continously do things they personally would prefer not to because their oath requires it. It's not idealistic at all. In an ideal world they'd let fat anti-vaxxers die instead of postponing medical treatment for other diseases because the IC is full.

Funny how you think talking like a street thug makes you think anybody will start believing you. As I thought, bluster and bullshit that ought to be ignored before people start worrying about going to the hospital to get help.

Sure. So send it via PM or it will have to be written off as bullshit. And whistleblower protections exist too. So one wonders why you come here alluding to serious problems without any proof. You'd think patients have a right to know their care isn't prioritised. But I suppose your job is more important than saving lives if what you say is true.

Seems the idea has very limited application but that's no bar for a patent application.

If a computer programmer of reasonable skill can setup what you're suggesting to do based on the above descriptions, then the idea has already been released into the public, which means it's no longer patentable.

Sure, why don't you share the protocol and health region you claim this is the case and I can do some sleuthing to confirm what you say is true instead of taking your word on a policy in clear violation of the hippocratic oath.

I can not speak directly to the treatment of only addicts in ICU with Covid. However (and this will raise a ton of naysayers who will refuse to believe me) the treatment protocols for Covid in the ICU for ventilated patients are designed primarily to reduce the number of viral particles expelled by the patient while ventilated. This is the first time I have ever seen a protocol for patient care that is based on fear of the infectious agent, rather than focused on patient recovery. — Book273

My neighbour is an anesthesist and he's calling this bullshit.

Hanover already is a dinosaur. He's developed a keen sense of when to not speak his mind lest the velicoraptors tear him a second butt hole.

I did find a way to export some things but it's only for specific pages you want to keep. For instance, I'm using the Pocket app so I can read the short stories on my e-reader.

Precisely why I'm against vaccine passports. People make shit choices all the time. I have a stressful job and exercise too little. I'm even aware I should be doing more about the latter but don't give it priority. It's relatively stupid but it's not as if it makes me Satan.

The fact nobody wants to be around philosophers does help.

What they never mentioned was how quickly the virus can circulate among the vaccinated. — NOS4A2

Who are they? Pfizer and Moderna did mention it: they didn't know what the effect was so that would be somewhere between no effect to herd immunity through vaccination and every possibility in between. If by they you mean governments, well, not the first time political decisions aren't fact based, or as I suspect in this case, incorrectly interpreted with a large serving of wishful thinking.

I'm not in favour of vaccine passports by the way but I wouldn't be even if vaccination would lead to herd immunity.

Well if you look at the claims around the phase 3 trial, it's only about the efficacy of the protection of the vaccinated. No discussion about herd immunity at all. This came indeed later, around May, because evidence showed it cut transmission by half and then the delta variant made that news old quickly.

I think it's because a lot of vaccines do result in herd immunity that a lot of people assumed this would be the case as well.

Pretty cool that you are personifying me in your head. I didn't realise I'm that important to you. Alas, you just sound like me reading text. Anyhoo, as to the subject, you're turning it around. Show me one expert that claimed the Pfizer vaccine would halt transmission. There aren't any.

Things like this is what I remember best:

https://medicalxpress.com/news/2021-05-evidence-covid-vaccines-transmission.html

https://www.theguardian.com/theobserver/commentisfree/2021/may/02/vaccinated-people-less-likely-to-pass-covid-on

It reduced transmission but didn't stop it.

What sources are you using for your impression of institutions being clear that the efficacy of the vaccines at reducing transmission was uncertain? — Isaac

Official statements by Pfizer and Moderna at the start of vaccination. I'm not aware of any other communication. And then came the good news that it reduces the rate of transmission of the alpha variant but that came again with the warning that is no guarantee for future variants.